4 comments:

The effect of Avastin/bevacizumab on glioma is quite complex and perplexing. You may find this article to be a bit more illuminating:

The paradoxical effect of bevacizumab in the therapy of malignant gliomashttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030223/

My wife was recently started on Avastin, after Stupp protocol + Opdivo/nivolumab in a clinical trial. The nivolumab caused *severe* cerebral edema, in the absence of any observed recurrence, after complete gross resection.

I pushed a bit for Avastin when decadron at 16 mg/d failed to help much with the edema symptoms. It's worked like a charm, and her decadron dose is down to 6 mg/d and still tapering.

We don't know whether or how much residual disease might be present--nothing has clearly shown up on scans so far.

My sense is that the greatest value of Avastin might be in avoiding high steroid doses, with the attendant immunosupprssive and other adverse side effects. I suspect it doesn't so much promote migration/invasion of malignant cells as *select for* sub-populations of malignant cells that already have a greater tendency to migrate/invade. Those malignant cells that tend more to stay in place and replicate get starved of blood supply, by the suppression of new blood vessel formation.

I suspect that Avastin as monotherapy in recurrence is likely to be a relatively poor treatment approach, but might be useful as a component of a multi-agent approach. With the cocktail approach, that's what we're aiming for. Meanwhile, the anti-edema effect of Avastin has been a godsend.

How quickly did the edema subside? My mom was on the Toca trial, but it caused excessive edema from the dead scar tissue and we had already been on dex for months, so we opted for the avastin+keytruda route. Currently only doing avastin, until we get keytruda approval from insurance.

My mom's edema has caused seizures, right side weakness, and speech problems. But, good news is no seen tumor (: maybe we're just antsy, but i'd really appreciate any anecdotes/insight into avastin!

In our case the Avastin resulted in substantial improvement in symptoms in 48 hours. An MRI a week after the second infusion showed almost complete resolution of the edema, despite tapering the decadron over this period of time from 16mg/d to 3mg/d. Our oncologist was surprised, but thrilled, by the speed and magnitude of the response.

It was unfortunate that we had to exit the nivolumab trial--Avastin wasn't permitted on the protocol. In our case, combined treatment might have controlled the edema from nivolumab, permitting longer treatment.

It's an unpredictable thing, who is going to respond to a given treatment. But our experience may give reason to have some optimism about your planned Avastin+Keytruda approach.